Malignant epithelial tumors are the main cancer-related cause of human death. These solid tumors frequently exhibit significant stromal reactions such as the so-called “desmoplastic stroma” or “reactive stroma”, which represents 20-60% of total tumor mass and is characterized by the existence of large numbers of stromal cells and dense extracellular matrix (ECM). Recent studies have indicated the tumor-promoting roles of stromal cells, as exemplified by vascular cells, immune cells, fibroblasts, myofibroblasts, adipocytes and bone marrow-derived progenitors (1-6). In particular, considerable numbers of cancer-associated fibroblasts (CAFs) are frequently observed within tumor-associated stroma of various human cancers, including breast, lung, colon, and pancreas carcinomas (14,15). Interacting coordinately with the different components of the stroma, CAFs have the ability to promote neoangiogenesis and tumor growth; CAFs have also been shown as crucial for the development of aggressive tumors and tumor invasiveness during cancer progression (16-25); CAFs facilitate the spreading and infiltration of tumor cells in distant organs, thus contributing to formation of metastases. Importantly, the relevance of stromal cells to the failure of systemic drug delivery to tumors and to the development of drug resistance has also been indicated (7-11). The identification of cellular and molecular targets abrogating stromal-tumor cell interactions and thus attenuating tumorigenesis is currently one of the most important subjects in translational oncology. Indeed, targeting the peritumoral stroma is a fairly new strategy to treat metastatic tumors, which represent more than 90% of cancer patient mortality: only a few products have obtained therapeutic approval up to now, most of them being anti-angiogenic drugs (Avastin®; 26). Identifying and targeting other new molecules within the tumor microenvironment is then essential for increasing the efficacy of conventional therapies in combination with the stroma-based therapeutic approaches, and represent a powerful approach for cancer and metastasis treatment (12, 13).
Monoclonal antibody (MAb)—based drugs represent a great promise in the fight against cancer. This is because they allow the treatment to be aimed at a molecular level in a precise and specific way. These advantages, together with their commercial appeal (short development times, restricted competence and being easily exportable to other cancer types once they have been approved), have pushed many pharmaceutical companies to invest heavily in the development of new antibody-based molecules, as well as in the in-licensing of new molecules or technologies from biotech companies.
However, despite the clinical success of therapeutic antibodies, naked MAbs targeting cell surface tumor antigens rarely present sufficient efficacy on their own. To increase the low activity of the MAbs, novel strategies are focusing on binding them to toxic molecules. Plant and bacterial toxins as well as small chemotherapeutic molecules can be good candidates, since they are very potent and active in very small quantities.
The field of immunotoxins (ITs) and Antibody-Drug conjugates (ADCs) for the treatment of cancer has recently experienced a growing development activity by pharmaceutical companies, due to the technological advances performed during the last years, aimed at solving the problems they initially presented about immunogenicity, undesirable toxicity, production, half-life and resistance.
Immunoconjugates are made of a human, humanized or chimeric recombinant antibody, covalently linked to a cytotoxic drug. The main goal of such a structure is joining the power of small cytotoxic (300 to 1000 Da) and the high specificity of tumor-associated antigen targeted (TAA) MAbs.
The Ab must be very selective to reach the antigen, whose expression must be restricted in normal cells. The Ab also must be internalized efficiently into the cancerous cells.
The cytotoxic agent selected as the effector moiety must kill cells only after internalization and release into the cell cytoplasm. The most commonly used payloads in ADCs are DNA-harming drugs such as calicheamicins, duocarmicins, or microtubule-targeting compounds like auristatins and maitansinoids.
The Ab-cytotoxic linkers are designed to be stable systemically and to release the cytotoxic within the target cells.
TAAs are frequently cell membrane proteins that are overexpressed in diseased tissues or at least expressed sufficiently to facilitate the internalization-activated cytotoxicity. Ideally the antigen presents a restricted expression in normal tissues with a low or absent expression in vital organs. On top of this, the tumor antigen must be recognized selectively and with high affinity by an Ab.
Recent studies suggest that therapeutic agents designed to inhibit TGF-β signaling pathway at the tumor-stroma interphase could prevent cancer progression, improving prognosis and treatment. TGF-β co-receptor family is emerging as a target for cancer treatments acting on the tumor or on its neovasculature. Endoglin (ENG, CD105), an accessory protein of the type II TGF-β receptor complex, is part of this family and presents the following characteristics:                Type I homodimer membrane protein        Cell surface angiogenesis and neovascularisation-associated protein in many cancer types        Overexpressed in tumor microvasculature cells, specifically in angiogenic areas of tumor        No expression in normal tissue endothelium        Breast metastasis-correlated plasma levels        Internalization        Optimal accessibility from bloodstream        
Anti-ENG antibodies (e.g. scFvs) have been reported and their application in tumor stroma targeting strategies described. Specific binding, cell internalization and anti-tumoral effects of Doxorubicin-loaded, anti-ENG immunoliposomes have been reported in vitro, using ENG+ cells, and in vivo in mice. ENG-targeted conjugates of anti-ENG antibodies and ricin or native nigrin b have been evaluated in mouse tumor models (27-36).
Despite these advances, there remains an unmet need for further therapeutic strategies for the treatment of tumors, including epithelial tumors, and for components for use in such therapeutic strategies. The present invention addresses these and other needs.